We address the problem of how to integrate health informa- tion systems in low-income African countries in which techni- cal infrastructure and human resources vary wildly within countries. We describe a set of tools to meet the needs of dif- ferent service areas including managing aggregate indicators, patient level record systems, and mobile tools for community outreach. We present the case of Sierra Leone and use this case to motivate and illustrate an architecture that allows us to provide services at each level of the health system (na- tional, regional, facility and community) and provide different configurations of the tools as appropriate for the individual area. Finally, we present a, collaborative implementation of this approach in Sierra Leone.